CPCS - Certified Provider Credentialing Specialist Peer Review and Performance Improvement Questions and Answers Flashcards
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Read the first 6 CPCS - Certified Provider Credentialing Specialist Peer Review and Performance Improvement Questions and Answers flashcards as text
What is the role of the credentialing specialist when FPPE results indicate a practitioner's performance is satisfactory?
Answer: Document the FPPE conclusion in the practitioner's credentials file and return the practitioner to routine OPPE monitoring
When FPPE findings confirm satisfactory performance, the credentialing specialist documents this outcome and transitions the practitioner back to standard OPPE.
Which metric is a common OPPE indicator used for surgical practitioners?
Answer: Surgical complication rates and unplanned return to the operating room rates
Procedure-specific outcome metrics such as complication rates and unplanned returns to the OR are standard OPPE indicators for surgical practitioners.
What does the Health Care Quality Improvement Act (HCQIA) of 1986 protect?
Answer: Peer review participants from monetary damages when conducting good-faith professional review activities
HCQIA provides immunity from civil money damages to participants in good-faith peer review activities that meet specified standards.
How frequently should OPPE data be reviewed for active medical staff members according to TJC standards?
Answer: Periodically, at intervals defined by the medical staff but often quarterly or semi-annually
TJC requires that OPPE data be reviewed at defined periodic intervals, which organizations typically set as quarterly or semi-annually.
Which of the following is a key distinction between quality management and peer review in healthcare organizations?
Answer: Quality management focuses on system-level process improvement, while peer review focuses on individual practitioner performance
Quality management addresses organizational systems and processes, whereas peer review evaluates individual practitioner clinical competence and performance.
When adverse privilege action is taken against a practitioner, what due process right must hospitals guarantee under HCQIA to receive immunity protections?
Answer: The practitioner must be given notice of the action and an opportunity for a hearing
HCQIA immunity requires that the affected practitioner receive adequate notice and an opportunity to be heard before or after the adverse action.